Breast Cancer

Nota:

• Lumpiness Pain Palpable mass due to fibrocystic change in the breast 

1. Initial Change
   1. Fibrocystic Change

      Nota:

      • Miscellary Change consists predominantly of cyst formation and fibrosis. A result occurs as a change occurs normally int he menstrual cycle.
      1. Proliferative Change

         Nota:

         • The spectrum of epithelial hyperplasia ranges from mild and orderly to atypical hyperplasias with features that resemble those of in situ carcinoma.
      2. Nonproliferative
      3. Link to Breast Carcinoma

         Nota:

         • Only way to make certain is thru biopsy and histologic examination. Link and trends are shown as below: Minimal: Fibrosis. Slight increased risk: Moderate to florid hyperplasia, ductal papilomatosis. sclerosing adenosis. Significantly increased risk: Atypical hyperplasia.
         1. Inflammatory Process

            Nota:

            • Uncommon, developed when bacteria usually staph aureus. Which gain access thru ducts... It induces acute inflammatory changes and profess to single and multiple abscesses. In infection, lining epithelium is destroyed and the ducts are filled with granular debris which sometime contains leukocytes and lipid-laden macrophages. Prominent lymphoplasmacytic infiltrate and occasional granulomas in the periducctal stroma.

Nota:

• 2nd most common cause of cancer death in females. 1 in 11 women will develop breast cancer by age 75

1. Risk Factors

   Nota:

   • Prolonged exposure to exogenous estrogens postmenopausally... Oral contraceptives may cause breast cancer, but its not shown to increase risk of breast cancer. Ionizing radiation to chest increase risk of breast cancer. Many other risk factors such as obesity, alcohol consumption etc etc.

1. Cysts and Fibrosis

   Nota:

   • Cysts may form within one breast and changes are multifocal and often bilateral.  They are brown to blue and filled with watery,turbid fluid. It may calcify to produce micro calcification on mammogram. Lining may be large and polygonal with abundant granular, eosinophilic cytoplasm and small, round deeply chromatic nuclei.i.e Apocrine metaplasia. Cysts range from less than 1 cm and up to 5 cm in diameter.
2. Invasive vs Non-invasive

   Nota:

   • All forms of breast cancer, local disease progression lead to similar findings, invasive cancers become adherent and fixed to the pec muscles or chest wall and overlying skin. It leads to retraction or dimpling of the skin or dimple. Involvement of lymphatic pathways may result in localise lymphedema. Skin becomes thickened around hair follicles, giving an appearance known as peau d'orange

1. Fibroadenoma

   Nota:

   • Most common benign neoplasm. Biphasic tumor composed of fibroblastic stroma and epithelium lined glands. Stroma are clone and truly neoplastic. Punctuated with softer yellow-pink specks representing glandular areas. Usually, a solitary, discrete, mobile mass. The tumour shows a uniform tan-white colour, with  Increase in oestrogen is thought to contribute to the development
   1. Pyllodes Tumor

      Nota:

      • Stromal elements are more cellular and abundant, forming epithelium lined leaflike projections. Usually benign. Malignancy includes increased stromal cellularity, anaplasia, high mitotic activity, rapid increase in size and infiltrative margins.
2. Intraductal Papilloma

   Nota:

   • Solitary and found within principal lactiferous ducts or sinuses. Presentation may include: Serous or bloody nipple discharge Presence of a small subareaolar timor a few millimetres in diameter In rare instances nipple retraction.
3. Carcinoma

Nota:

• 3 sets of influences seems to be important 1. Genetic changes 2. hormonal influences 3. Environmental variables

1. Genetic change

   Nota:

   • Best-characterized is the over expression of the HER2/NEU pro to-oncogene Amplification of RAS and MYC genes also has been reported in some human breast cancers. Deficiency and mutation of RB and TP53 10% of the breast cancers are related to specific inherited mutations. with it about 1/3 of the woman with hereditary breast cancers have mutations in BRCA1 /2 (DNA repair pathway)
2. Hormonal/Environmental

   Nota:

   • Estrogen excess has a significant role.

Nota:

• It spread via the lymphatic and hematogenous channels. Nodes to spread thru axillary nodes, It travel first into lymph nodes along internal mammary arteries, and more distant dissemination.... Favoured location is lung, skeleton liver, adrenals or brain.