Breast cancer forms in the breast tissues and spreads mainly through the lymphatic system. Risk factors include gender, age, family history, and certain lifestyle habits. Signs include lumps, skin changes, and nipple discharge. Diagnosis involves exams, mammograms, biopsies and imaging tests. The cancer is staged based on tumor size, lymph node involvement and metastasis. Treatment options include surgery, radiation therapy, drug therapy, and chemotherapy. Radiation therapy is delivered in multiple sessions over several weeks and aims to kill cancer cells while minimizing side effects like skin changes, fatigue and nerve damage.

1. BREAST CANCER
Presented by:- INDRANIL MITRA
KAJAL MISHRA
(Trainee, HCG Bangalore)

2. What is cancer??
Cancer is the abnormal ,uncontrollable,
continuous replication of cells which will lead
to the formation of a tumour.

3. 
Breast cancer is a malignant (cancerous) tumour
that starts in the cells of the breast. It is found
mostly in women, but men can get breast cancer,
too.
What is Breast Cancer ?

4. Etiology of breast cancer:-
• Etiology is the study of the causes or origin of
disease.
• Random changes or mutations in the body’s
DNA is what causes breast cancer to occur.
• These changes in DNA are passed down from
one generation to another.

5. Anatomy:-

7. THE NORMAL BREAST:-
1. Chest wall.
2. Pectoral muscles.
3. Lobules (glands that make milk).
4. Nipple surface.
5. Areola.
6. Lactiferous duct tube that carries
milk to the nipple
7. Fatty tissue.
8. Skin.

8. Breast cancer area
Forms in the
tissues of the
breast
Spreads mainly
through the
Lymphatic system

9. What is RISK FACTORS in Breast Cancer ?
•Risk factors increases the chances
of having breast cancer but does
not causes it.

10. FACTORS THAT CONTRIBUTES TO
BREAST CANCER:-
• Gender
• Age
• Genetic risk factors
• Family history
• Personal history of breast
cancer
• Dense breasts tissue
• Certain benign (not cancer)
breast problems
• Menstrual periods

11. FACTORS THAT CONTRIBUTES TO
BREAST CANCER:-
• Not having children or having
them later in life.
• Certain kinds of birth control.
• Using hormone therapy after
menopause.
• Not breastfeeding.
• Alcohol.
• Being overweight or obese
• Tobacco Smoking may
increase the risk of breast
cancer.

12. SIGNS AND SYMPTOMS OF BREAST
CANCER:-
• A lump in a breast.
• A pain in the armpits or breast that does not seem to be related to
the woman's menstrual period.
• Pitting or redness of the skin of the breast; like the skin of an
orange.
• A rash around (or on) one of the nipples.
• A swelling (lump) in one of the armpits.
• An area of thickened tissue in a breast.
• One of the nipples has a discharge; sometimes it may contain blood

13. SIGNS AND SYMPTOMS OF BREAST
CANCER:-
• The nipple changes in appearance; it may
become sunken or inverted.
• The size or the shape of the breast changes.
• The nipple-skin or breast-skin may have started
to peel, scale or flake.

14. SIGNS OF BREAST CANCER

16. BREAST TUMORS
Malignant Benign
• Cancerous • Not - Cancerous

17. BENIGN TUMORS:-
• Not cancerous.
• Cysts are fluid-filled sacs.
• Benign breast tumours are
abnormal growths, but they do
not spread outside of the
breast and they are not life
threatening.
• Most lumps are caused by the
combination of cysts and fibrosis
• Fibrosis is the formation of scar -
like tissue.
• These changes can cause breast
swelling and pain.

18. Breast Cancer:- (two types)
Invasive Non - Invasive
• Cancerous
• Malignant
• Spreads to other organs
(metastasis).
• Pre – Cancerous
• Still in its original position
• Eventually develops into
invasive breast cancer.

20. METHODS OF DIAGNOSIS:-
• Diagnostic tests and procedures for
• breast cancer include:
• Breast exam
• Mammograms Imaging tests
• Breast MRI scan
• Biopsy

21. TESTS TO FIND WHETHER THE CANCER
HAS SPREAD:-
• Chest x-ray: the lungs.
• Bone scan: the bones.
• CT scan (computed tomography): the chest
and/or abdomen.
• MRI : brain and spinal cord.
• Ultrasound: other parts

22. STAGING OF BREAST CANCER:-
The TNM staging system
This system takes into account:
• the tumour size and spread (T),
• whether the cancer has spread to lymph nodes
(N) and
• whether it has spread to distant organs (M) for
metastasis.

23. STAGING OF BREAST CANCER:-
• Sage 0 : Non – Invasive breast cancer. Has not
spread to breast tissues.
• Stage l : ≤ 2cm and has not spread to lymph nodes.
• Stage ll
1. Stage llA: ≤ 2 cm and has spread to lymph nodes
or 2-5 cm and has spread to lymph nodes.
2. Stage llB: 2-5 cm and has spread to lymph nodes
or > 5 cm and has not spread to lymph nodes.

24. STAGING OF BREAST CANCER
• Stage lll
Stage lllA: ≤ 5cm and spread to lymph nodes
forming clumps or >5 cm and spread to lymph
nodes without forming clumps.
Stage lllB: Any size and spread to the skin or
chest wall. Swelling.
Stage lllC: Any size , spread to lymph nodes, skin
and chest wall.
Stage lV: Metastasized

26. SURVIVAL RATES

28. THE MAIN BREAST CANCER TREATMENT
OPTIONS MAY INCLUDE:-
• Surgery
• Radiation therapy
• Biological therapy (targeted drug therapy)
• Chemotherapy

29. RADIATION THERAPY FOR BREAST
CANCER:-
• Radiation therapy is treatment with high-energy
rays (such as x-rays) to kill cancer cells.
• The patient may require three to five sessions
per week for three to six weeks.
• The type of breast cancer will determine the type
of radiation therapy used.

30. Immobilization methods for
radiotherapy:-
breast board

32. Vac-lock:-

33. TYPES OF RADIATION THERAPHY:-
• Breast radiation therapy – applied after a lumpectomy,.
• Chest wall radiation therapy – applied after a
mastectomy
• Breast boost - a high-dose of radiation therapy is applied
to where the tumour was surgically removed.
• Lymph nodes radiation therapy - aimed at the axilla and
surrounding area to destroy cancer cells that have
reached the lymph nodes
• Brachytherapy

34. For tangential fields:-
• Upper border – when supra clavicular field used.
• When SCF not irradiated – head of clavicle
• Medial border – at or 1cm away from midline
• Lateral border – 2-3cm beyond all palpable breast tissue
– mid axillary line
• Lower border – 2cm below inframammary fold
• Anterior -2cm margin of light, above the highest point of
breast.

36. Importance of beam modification
devices (wedges):-

37. Bolus:-
• Increases dose to skin & scar after mastectomy
• Universal wax bolus used

38. Boost-electrons:-
• Appropriate energy selected to allow 85 -90%
isodose line to target volume & decrease dose to
the lung.
• Energy – 9-16 MeV
• Dose – 10-20Gy

39. Role of IMRT in breast cancer:-
• (1) Better dose homogeneity for whole breast RT
• (2) Better coverage of tumor cavity
• (3) Decrease dose to the critical organs
• (4) Left sided tumors- decrease heart dose

40. SIDE EFFECTS OF RADIATION
THERAPHY:-
• Swelling and heaviness in the breast.
• Sunburn-like changes in the skin and feeling very
tired.
• Weakness .
• Damage some of the nerves to the arm. This can lead
to numbness, pain, and weakness in the shoulder,
arm and hand.
• Radiation to lymph nodes causes (Lymphedema).