An overview of Breast cancer; causes, symptoms, examination, treatment... etc.

1. King Faisal University
College of Medicine
Block 1.1
Hasan Radi Al-Shabaan
214010094
Group: 3
Serial number: 31
Tutor: Dr. Ahmed Ramadan

2. Learning Objectives
 Definition and epidemiology of breast cancer.
 Anatomy of the breast.
 Signs and symptoms of breast cancer.
 Types of breast cancer.
 Stages of breast cancer.
 Grades of breast cancer.
 Methods of spread.
 Causes of breast cancer.
 Methods of examination.
 Methods of screening.
 Prevention & treatment.

3. Anatomy of the breast
Shape and position:
 conical in shape
 It extends from the sternum
margin to the midaxillary line
at the level of 4th rib.
 Vertically, it extends from
the 2nd rib to the 6th rib
along the midclavicular line.

4. Anatomy of the breast
 Parts of the breasts:
1- The nipple and areola
• The nipple is a conical
or cylindrical prominent.
• It lies below the center
of the breast and opposite
of the 4th intercostal space.

5.  The areola:
 Areola is a circular patch of pigmented skin surrounding
the nipple.
 The areola contains many sebaceous glands.
 During pregnancy, the areola undergo some changes.

6. 2-The breast.
 It consists of the parenchyma,
stroma and the overlying skin.

7.  The Parenchyma:
 The parenchyma is the mammary
glands and the lactiferous ducts.
 The mammary glands:
 It is a modified sweat gland.
 It consists of 15-20 lobes.
lobe lobules ductule Lactiferous
ducts

8.  The lactiferous ducts:
 converge toward the nipple.
 Each duct dilates under the
areola to form lactiferous sinus.
 Lactiferous sinus narrows
again and open separately
on the summit of the nipple.

9.  2- The stroma:
 It is the superficial fascia
of the pectoral region.
 It consists of fat and fibrous strands.
 The fat surrounding the parenchyma
- smooth rounded contour of the breast.
 Fibrous strands known as
cooper’s ligaments - suspend
the breast on the chest wall.

10.  The coopers ligaments extends from the skin to the deep
membranous layer of the superficial fascia.
 These ligaments maintain the protuberance of the
breast.
 In cancer breast
It becomes like an orange
“peau d'orange”

11. Anatomy of the breast
 Lymph nodes
1- The anterior (pectoral) group
2- the posterior (subscapular) group
3 – The apical group
4- central basal group
5- lateral (brachial) group

12.  Lymphatic drainage of the breast:
1- A superficial plexus ( subareolar lymphatic plexus )
* Under the areola
2- A deep lymphatic plexus on deep fascia of the pectoralis
major underlying the breast.
• Located within the retromammary space.
These two plexuses communicate freely.

13. 1-subareolar lymphatic plexus
2-deep lymphatic plexus

14. Lymphatic drainage of the breast:
1- The central and the lateral part of the gland drain into the
anterior group.
2- The tail of the breast drain into the posterior group.
3- the upper part of the gland drain into the apical group of the
axillary lymph nodes and the lower deep cervical lymph nodes.
4- The medial part of the
gland drains into
the parasternal lymph nodes

15. Signs and symptoms
 A lump in the breast
 Swelling in or around the
breast, collarbone, or armpit
 Skin thickening or redness
 Nipple changes
 Nipple discharge
 Pain

16. Signs and symptoms

17. Types of breast cancer
 A- Non-invasive:
 1- Ductal Carcinoma In Situ, where abnormal cells have
been contained in the lining of the breast milk duct.
 2- Lobular Carcinoma In Situ, abnormal cells form in the
lobules or milk glands in the breast

18. Types of breast cancer
 B- Invasive:
 1- Invasive Ductal Carcinoma, abnormal cells that
originated in the lining of the milk ducts have invaded
surrounding tissue.

19. Types of breast cancer
 2- Invasive Lobular Carcinoma, the cancer began in the
lobules and has spread into the surrounding breast tissue.

20. Types of breast cancer
 3-Medullary carcinoma, a rare subtype of invasive ductal
carcinoma.
 Medullary tumors are often “triple-negative”, which means
that they test negative for estrogen and progesterone
receptors, as well as for the HER2/neu protein.

21. Types of breast cancer
 4- Colloid (mucinous) Carcinoma, the tumor cells produce
abundant amounts of extracellular mucin

22. Types of breast cancer
 5- Tubular Carcinoma, usually small (about 1 cm or less)
and made up of tube-shaped structures called "tubules”
 It is usually found through a mammogram

23. Stages of breast cancer

24. Stage I

25. Stage IIA

26. Stage IIB

27. Stage IIIA

28. Stage IIIB

29. Stage IIIC

30. Stage IV

31. grades of breast cancer
Grade 1 (low-grade) – The cancer cells look
similar to normal cells and grow very slowly.
Grade 2 (moderate- or intermediate-grade)
– The cancer cells look more abnormal and
are slightly faster growing.
Grade 3 (high-grade) – The cancer cells
look very different from normal cells and
tend to grow quickly.

32. Methods of spread
 There are three ways that cancer spreads in the body.
 Cancer can spread through tissue, the lymph system, and
the blood:
 Tissue. The cancer spreads from where it began by
growing into nearby areas.
 Lymph system. The cancer spreads from where it began
by getting into the lymph system. The cancer travels
through the lymph vessels to other parts of the body.
 Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood
vessels to other parts of the body.

33. Causes of breast cancer
 Three sets of influences: genetic changes, hormonal
influences and environmental variables.
 1- Genetic Changes:
 Overexpression of the HER2/NEU proto-oncogene
 BRCA1 and BRCA2 are tumor suppressor genes. When
one of these genes are mutated, it no longer suppresses
abnormal growth, and cancer is more likely to develop.

34. Causes of breast cancer
 2- Hormonal Influences:
 Endogenous estrogen excess (long duration of
reproductive life, late age at birth of the first child)
 Hormone replacement therapy
 3-Environmental variables:
 Radiation.

35. Diagnosis of breast cancer
 1- Asking about history
 Family history
 Personal history
 Having a previous cancer in breast, uterine, ovarian, or
colon increase the chance of having breast cancer.

36. 2- Physical Examination
 Clinical breast exam:
- Breasts, armpits, and the neck and chest area should be
examined.
- The physician should examine the axillary lymph nodes
- These sites should be examined twice, when the patient is
sitting up and when she is lying down.
* The clinical breast exam is done annually by the family
physician or gynecologist

37.  Breast self-examination
 breast self-exam is done
once at month at home

38.  3- Investigation:
 Mammography, to screen
for breast cancer or help
identify the breast lump.
 Breast MRI, to help better
identify the breast lump

39. Methods of screening
 Mammogram: every two years for women 50-74 years.
 Clinical Breast Exam: every year for women 40 years or
older.
 Breast self-exam: every month for women starting in
their 20s

40.  Breast ultrasound, to show whether
the lump is solid or fluid-filled
 Breast biopsy, to determine whether
or not a lump is cancer and,
if it is cancer, what type it is.

41. Prevention
 Physical exercise.
 Limit hormone therapy.
 Breast cancer screening .
 Breastfeeding.
 Alcohol consumption .

42. Treatment
 1- Surgery:
 breast-conserving surgery:
Surgery to remove just the cancerous lump (tumor).
 it includes:
 Lumpectomy:
 Partial mastectomy (segmental mastectomy)

43.  Mastectomy:
 Surgery to remove the whole breast.
All of the breast tissue is removed,
sometimes along with other nearby tissues.
 It includes:
 Total (Simple) mastectomy
 Modified radical mastectomy
 Radical mastectomy

44.  Lymph node surgery:
 To find out if the breast cancer has spread to axillary
lymph nodes, one or more of these lymph nodes may be
removed and looked at under the microscope.
 Ways to check these lymph nodes:
 Axillary lymph node dissection
 Sentinel lymph node biopsy

45.  2. Chemotherapy:
 Chemotherapy is usually used after surgery,It uses drugs
to stop the growth of cancer cells, either by killing the
cells or by stopping them from dividing.
 Types of chemotherapy:
 Systemic chemotherapy
 Regional chemotherapy

46.  3. Radiotherapy:
 Radiotherapy is generally given after surgery and
chemotherapy, it uses high-energy x-rays or other types
of radiation, to kill remaining cancer cells or keep them
from growing.
 Types of radiotherapy:
 External radiation
 Internal radiation

47.  4. Hormone therapy:
 It is usually given before surgery and chemotherapy, but
sometimes it is given before surgery to shrik a tumor,
making it easier to remove.
 Some hormones (estrogen or progesterone)
 can cause certain cancers to grow, hormone therapy
lowers the levels of hormones or blocks their action and
stops cancer cells from growing.

48. 5. Targeted Therapy (Biological Therapy):
 A certain protein called human epidermal growth factor
receptor 2 (HER2) makes cancer cells grow and spread
faster. Biological therapy works by stopping the effects of
HER2 and by helping the immune system fight off cancer
cells.

49. References
 Robbins Basic Pathology, 9th edition
 http://www.cancer.gov/cancertopics/pdq/treatment/bre
ast/Patient/page2
 http://www.cdc.gov/cancer/breast/basic_info/screening.
htm
 http://www.nationalbreastcancer.org/types-of-breast-cancer