Breast Lump

Normal structure and function of breast
1. Pair of modified sweat glands
  1. Location
    1. Superficial fascia of pectoral region
  2. Functional parts
    1. Epithelial part
      1. Milk production
    2. Connective tissue part
      1. Make up and support
      2. Coopers Ligament
2. Lymph drainage
3. Hormones
  1. Estrogen
    1. Ductal development
  2. Progesterone
    1. Lobular development and differentiation of epithelium
  3. Prolactin
    1. Lactogenesis
4. Tanner stages
Cancer
1. Epidemiology
  1. Estimated Mortality rate worldwide (All ages)
  2. UAE
2. Classification
  1. Ductal
    1. In situ (DCIS)
      1. Malignant proliferation of the cell in ducts
      2. No invasion
      3. Mammography > calcification > biopsy
      4. Paget's disease
        DCIS involve the nipple
    2. Invasive
      1. Duct-like structure and desmoplastic stroma
      2. Present as a mass
      3. 4 subtypes
        Tubular
        Tubule lacks myoepithelial cells
        Good prognosis
        Medullary
        High-grade cells / Lymphocytes / Plasma cells
        Good prognosis
        BRCA 1
        Mucinous
        Tubule in mucus pools
        Good prognosis
        Older women
        Inflammatory
        In dermal lymphatics
        Inflamed swollen breast
        Poor prognosis
  2. Tubular / Lobular
    1. In situ (LCIS)
      1. Malignant proliferation of the cell in lobule
      2. No invasion
      3. No mass or calcification
      4. Dyscohesive cells
      5. Multifocal and bilateral
      6. Responsd to tamoxifen
    2. Invasive
      1. Single file pattern
      2. Signet cell morphology
      3. No duct formation
        Lack E-cadherin
3. Staining
  1. Estrogen and progesterone receptor
    1. Designed antibodies against them
    2. Inside the nucleus
  2. HER2/neu amplification
    1. A growth factor receptor
    2. Designed antibodies against HER2 receptor
    3. On the cell surface
4. Genetic mutations
  2. Repair DNA damage
    1. BRCA1 and BRCA2
    2. ATM
      1. Ataxia-telangiectasia
    3. BRIP1
    4. BARD1
      2. Works with BRCA1
    5. MRE11A
      1. Ataxia-telangiectasia-like disorder
    6. NBN
      1. Nijmegen breakage syndrome
    7. RAD50
    8. MSH6 and PMS2
      1. Mismatch repair genes
      2. Lynch syndrome
    9. PALB2
      1. Partner and localizer of BRCA 2
      2. Breast cancer
    10. RAD51C
      1. Breast and ovarian cancer
  3. Tumor suppressor gene
    1. TP53
      1. Li-Fraumeni syndrome
    2. CHEK2
      1. Cancer: breast / colon / prostate
    3. PTEN
      1. Cowden syndrome
    4. STK11
      1. Peutz Jegher syndrome
  4. Helps cells to bind together
    1. CDH1
      1. Stomach cancer / Invasive lobular breast cancer
  5. Screening
    1. DNA Microarrays Technology
      1. Show the expression of the genes
5. Grading
  1. Grade 1
    1. Well differentiated
      1. Most like normal breast cells and usually slow-growing
  2. Grade 2
    1. Moderately differentiated
      1. Less like normal cells and is growing faster
  3. Grade 3
    1. Poorly differentiated
      1. Different to normal breast cells and is usually fast-growing
6. Staging
  1. TNM staging system
    1. 5 stages
    2. T: Tumor
    3. N: Lymph node
    4. M: Metastasis
7. Molecular classification
  1. Luminal A
    1. Hormone-receptor positive (ER and/or PR positive)
    2. HER2 negative
  2. Luminal B
    1. Hormone-receptor positive (ER and/or PR positive)
    2. Faster than luminal A
    3. HER2 either positive or negative
  3. Triple-negative/basal-like
    1. Hormone-receptor negative (ER and PR negative)
    2. Common in BRCA 1mutation
    3. HER2 negative
  4. HER2-enriched
    1. Hormone-receptor negative (ER and PR negative)
    2. HER2 positive
  5. Normal-like
    1. Similar to luminal A
    2. Worse prognosis than luminal A
8. Factors
  1. Risk
    1. Female gender
    2. Advancing age
    3. Family history
    4. Ethnicity
    5. Early menstrual period
  2. Protective
    1. Healthy weight
    2. Breastfeeding
    3. Limiting alcohol intake
    4. Exercise
    5. Multiple pregnancy
9. Diagnosis
  1. Examinations
    1. Physical
    2. Self
  2. Investigations
    1. Mammogram
      1. Types
        Screening
        Diagnostic
      2. Disadvantages
        False-positive results
        Overdiagnosis and overtreatment
        False-negative results
    2. Ultrasound
      1. Detect abnormality type
    3. MRI
      1. Screening high-risk women
      2. Monitoring treatment
    4. Biopsy
      1. Fine needle aspiration biopsy
      2. Core needle biopsy
      3. Vacuum-assisted breast biopsy (guided)
      4. Surgical Biopsy
    5. Blood tests
      1. Markers
        CA 15.3 / TRU-QUANT/ CA 27.29 / CA125
        Progression / Recurrence / Expensive
10. Management
  1. Local
    1. Surgery
      1. Lumpectomy
      2. Mastectomy
        Subtypes
        Radical mastectomy
        Modified radical mastectomy
        Simple mastectomy
        Skin-sparing mastectomy
        Pre-operative management
        Discontinuation of Aspirin
        Echocardiogram
        Chest X-ray
      3. To remove lymph nodes
        Sentinel lymph node biopsy (SLNB)
        Axillary lymph node dissection (ALND)
        Surgery for advanced breast cancer
      4. Breast reconstruction
        Implant reconstruction
        Autologous or "flap" reconstruction
        Tissue expansion
    2. Radiation Therapy
  2. Systemic
    1. Chemotherapy
      1. Neoadjuvant
      2. Adjuvant
    2. Hormonal therapy
      1. ER or PR positive breast cancer
    3. Targeted therapy
      1. HER2-positive breast cancer
  3. Post-operative pain
    1. Short-acting anesthetic bupivacaine
    2. Psychoeducation
  4. Follow up
    1. Doctor visits
    2. Mammograms
    3. Pelvic exams
    4. Bone density tests
    5. Other tests
11. Prognosis
  1. Depends on many factors
  2. 5-year survival rate
    1. Average is 90%
    2. Located only in breast is 99%
    3. In regional lymph nodes is 85%
    4. In metastasis is 27%
  3. 10-year survival rate is 83%

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Breast Lump

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	Criado por Moza Almualla quase 6 anos atrás