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A 36 yr old woman with Breast lump

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Mind Map on A 36 yr old woman with Breast lump, created by rania jumah on 25/02/2021.
rania jumah
Mind Map by rania jumah, updated more than 1 year ago
rania jumah
Created by rania jumah almost 4 years ago
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Resource summary

A 36 yr old woman with Breast lump
  1. Anatomy of breast
    1. epithelial part
      1. milk production
      2. connective tissue part
        1. cooopers ligament
        2. blood supply
          1. internal mammary artery
            1. acromiothoracic artery & intercostal arteries
              1. lateral thoracic artery
              2. lymphatic drainge
                1. lateral axillary node
                  1. pectoral nodes
                    1. subscapular nodes
                      1. central axillary nodes
                        1. infraclavicular nodes
                          1. parasternal nodes
                            1. supraclavicular nodes
                              1. apical axillary
                                1. ant./post. axillary
                              2. physiology of breast
                                1. estrogen
                                  1. development of stromal tissue of breast
                                    1. involved in ductal development
                                      1. 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
                                        2. prolactin
                                          1. most imp hormone for lactogenesis in late pregnancy and postpartum period
                                            1. lactation
                                              1. mammogenesis
                                                1. process of growth & development of mammary gland
                                                2. lactogenesis
                                                  1. initiation of milk secretion
                                                  2. galactopoiesis
                                                    1. maintenance of milk secretion
                                                    2. milk -let down reflex
                                                      1. oxytocin
                                                        1. contraction of myoepithelial cells
                                              2. went for a routine health check
                                                1. mammogram performed
                                                  1. lesions identified
                                                    1. history was taken
                                                      1. family history of breast cancer
                                                        1. risk factor for breast cancer
                                                          1. advancing age
                                                            1. female gender
                                                              1. ethnicity
                                                                1. white women
                                                                2. hormone replacement therapy
                                                                  1. first child after age 30
                                                                    1. overweight and obese women
                                                                      1. alcohol/smoking
                                                                        1. early period and late menopause
                                                                    2. physical exam done
                                                                      1. breast examination
                                                                        1. no nipple discharge
                                                                          1. no axillary lymphadenopathy
                                                                            1. no palpable breast mass
                                                                              1. wide local excision of breast lump performed
                                                                                1. revealed infiltrating ductal breast carcinoma
                                                                                  1. Breast carcinoma
                                                                                    1. management
                                                                                      1. systemic
                                                                                        1. chemotherapy
                                                                                          1. cyclophosphamide
                                                                                            1. doxorubicin
                                                                                              1. methotrextate
                                                                                              2. hormonal therapy
                                                                                                1. ER positive
                                                                                                  1. PR positive
                                                                                                  2. targeted therapy
                                                                                                    1. HER-2 targeted therapies
                                                                                                  3. local
                                                                                                    1. surgery
                                                                                                      1. lumpectomy
                                                                                                        1. advatage: preserve appearance and less invasive
                                                                                                          1. disadvenatge: radical therpay may be needed after and chances of local reoccurance
                                                                                                            1. contrainfications"
                                                                                                              1. previous radiation/multiple masses/large tumors
                                                                                                            2. mastectomy
                                                                                                              1. subtypes
                                                                                                                1. modified radical mastectomy/radical mastectomy/simple mastectomy/skin sparingmastectomy
                                                                                                                2. indications
                                                                                                                  1. previous radiation/multiple masses/large tumor/ diffsue malignant carcionma
                                                                                                                3. breast reconstruction
                                                                                                                  1. tissue expansion
                                                                                                                    1. flap reconstruction
                                                                                                                      1. indications
                                                                                                                        1. previous radiotheraphy, radical mastectomy, tight mastectomy scar
                                                                                                                      2. implant reconstruction
                                                                                                                4. Follow up
                                                                                                                  1. measure level of blood tumor markers
                                                                                                                    1. pelvic exam
                                                                                                                      1. doctor visits
                                                                                                                        1. imaging tests
                                                                                                                          1. mammograma
                                                                                                                          2. prognosis
                                                                                                                            1. average 5 year survival rate ior people with breast cancer is 90%
                                                                                                                              1. average 10 year survival for breast cancer is 85%
                                                                                                                                1. if spread to regional lymph nodes 5 year survival is 83%
                                                                                                                                  1. if cancer spreads to distant parts of body 5 year survival rate is 27%
                                                                                                                                  2. classification
                                                                                                                                    1. ductal
                                                                                                                                      1. ductal carcinoma in situ
                                                                                                                                        1. malignant proliferation of cells in duct
                                                                                                                                          1. no invasion to basement membrane
                                                                                                                                            1. it doesnt produce mass, detected as calcification
                                                                                                                                              1. paget disease
                                                                                                                                                1. DIC that extends up tp duct and invade skin of nipple
                                                                                                                                                  1. nipple ulceration and erythema
                                                                                                                                              2. invasive ductal carcinoma
                                                                                                                                                1. present as mass
                                                                                                                                                  1. has 4 subtypes
                                                                                                                                                    1. tubular
                                                                                                                                                      1. good progosis
                                                                                                                                                        1. tumor lacks myoepithelial cells
                                                                                                                                                        2. medullary
                                                                                                                                                          1. hih grade cells. lymphomas and plasma cells
                                                                                                                                                            1. good prognosis
                                                                                                                                                            2. mucinous
                                                                                                                                                              1. tubules in mucus pools
                                                                                                                                                                1. good prognosis
                                                                                                                                                                2. inflammatory
                                                                                                                                                                  1. poor prognosis, in old woman, in dermal lympahtics, inflammed swollen breasts
                                                                                                                                                            3. tubular
                                                                                                                                                              1. lobular carcinoma in situ
                                                                                                                                                                1. multifocal & bilateral
                                                                                                                                                                  1. no invasion, masses or calcifications
                                                                                                                                                                    1. discovered by accident
                                                                                                                                                                    2. malignant proliferation of cell in lobule
                                                                                                                                                                    3. invasive lobular carcinoma
                                                                                                                                                                      1. single file pattern
                                                                                                                                                                        1. signet cell morphology
                                                                                                                                                                          1. no duct formation
                                                                                                                                                                            1. lacks f-cadherin
                                                                                                                                                                      2. investigations
                                                                                                                                                                        1. blood tests
                                                                                                                                                                          1. tumor markers
                                                                                                                                                                            1. tissue tumor markers
                                                                                                                                                                              1. estrogen and progesterone receptors
                                                                                                                                                                                1. human epidernal growth factor
                                                                                                                                                                                2. serum tumor markers
                                                                                                                                                                                  1. CEA
                                                                                                                                                                                    1. CA 27.29
                                                                                                                                                                                      1. CA 15-3
                                                                                                                                                                                  2. biopsy
                                                                                                                                                                                    1. fine needle aspiration
                                                                                                                                                                                      1. core needle biopsy
                                                                                                                                                                                        1. surgical biopsy
                                                                                                                                                                                        2. mammogram
                                                                                                                                                                                          1. MRI
                                                                                                                                                                                            1. gather more information about area of suspicion
                                                                                                                                                                                              1. screen high risk women
                                                                                                                                                                                                1. moniter treatment
                                                                                                                                                                                                2. ultrasound
                                                                                                                                                                                                  1. usuualy after mamogram
                                                                                                                                                                                                    1. detect abnormality type
                                                                                                                                                                                                      1. before mammogram to evaluate lump
                                                                                                                                                                                                    2. molecular classification
                                                                                                                                                                                                      1. Luminal A
                                                                                                                                                                                                        1. ER+
                                                                                                                                                                                                        2. luminal B
                                                                                                                                                                                                          1. ER+ HER2+
                                                                                                                                                                                                          2. her2 +ve
                                                                                                                                                                                                            1. HER2-
                                                                                                                                                                                                            2. basal like
                                                                                                                                                                                                              1. 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
                                                                                                                                                                                                    2. 40s
                                                                                                                                                                                                      1. 45+ every year
                                                                                                                                                                                                    3. disadventages
                                                                                                                                                                                                      1. false negative results
                                                                                                                                                                                                        1. overdiagnosis and overtreatment
                                                                                                                                                                                                          1. false positive results
                                                                                                                                                                                                          2. types of mammograms
                                                                                                                                                                                                            1. screening mammography
                                                                                                                                                                                                              1. diagnostic mammography
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