Presentasi ca mammae

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Presentasi ca mammae

  1. 1. 6 JUN 10 FF6 JUN 10 FF 11BREAST CANCERBREAST CANCERBYBYDR.T.FARIZAL FADIL Sp.BDR.T.FARIZAL FADIL Sp.B
  2. 2. 6 JUN 10 FF6 JUN 10 FF 22Breast cancer is an uncontrolled growth ofBreast cancer is an uncontrolled growth ofbreast cells or breast tissue, which canbreast cells or breast tissue, which canoccur in both women and men. Worldwide,occur in both women and men. Worldwide,breast cancerbreast cancer is the fifth most commonis the fifth most commoncause of cancer death (after lung cancer,cause of cancer death (after lung cancer,stomach cancer, liver cancer, and colonstomach cancer, liver cancer, and coloncancer)cancer)
  3. 3. 6 JUN 10 FF6 JUN 10 FF 33Breast CancerBreast CancerBreast cancer is an uncontrolled growth of breast cells or breast tissue,Breast cancer is an uncontrolled growth of breast cells or breast tissue,which can occur in both women and men. Worldwide,which can occur in both women and men. Worldwide, breast cancerbreast cancer is theis thefifth most common cause of cancer death (after lung cancer, stomachfifth most common cause of cancer death (after lung cancer, stomachcancer, liver cancer, and colon cancer).cancer, liver cancer, and colon cancer).No one knows why some women get breast cancer, but Breast cancer theNo one knows why some women get breast cancer, but Breast cancer themost common cause by :most common cause by : Age, the chance ofAge, the chance of getting breast cancergetting breast cancer rises as a woman gets olderrises as a woman gets older Genes, there are two genes, BRCA1 and BRCA2, that greatly increase theGenes, there are two genes, BRCA1 and BRCA2, that greatly increase therisk. Having one close relative (mother or sister) with breast cancer doublesrisk. Having one close relative (mother or sister) with breast cancer doublesyour risk of getting breast canceryour risk of getting breast cancer Certain Medications, Taking hormone replacement therapy (HRT) drugsCertain Medications, Taking hormone replacement therapy (HRT) drugsafter menopause may increase your chance of getting breast cancer.after menopause may increase your chance of getting breast cancer. Personal factors, beginning periods before age 12 or going throughPersonal factors, beginning periods before age 12 or going throughmenopause after agemenopause after age
  4. 4. 6 JUN 10 FF6 JUN 10 FF 44 Symptoms & DiagnosisSymptoms & Diagnosis ::If you discover a persistent lump in your breastIf you discover a persistent lump in your breastor any changes in breast tissue, it is veryor any changes in breast tissue, it is veryimportant that you see a physician immediately.important that you see a physician immediately.Other thing that you should See your healthOther thing that you should See your healthprofessional if :professional if :- A new lump in the breast- A new lump in the breast- A lump that has changed- A lump that has changed- change in the size or shape of the breast- change in the size or shape of the breast- Pain in the breast or nipple that does not go- Pain in the breast or nipple that does not goawayaway- Skin anywhere on the breast that is flaky, red,- Skin anywhere on the breast that is flaky, red,or swollenor swollen- A nipple that is very tender or that suddenly- A nipple that is very tender or that suddenlyturns inwardturns inward- Fluid coming from the nipple when not nursing- Fluid coming from the nipple when not nursinga babya baby
  5. 5. 6 JUN 10 FF6 JUN 10 FF 55 The most important method used toThe most important method used todiagnose breast cancer is by taking adiagnose breast cancer is by taking abiopsy (abiopsy (a tissue sampletissue sample), The shape and), The shape andappearance of the cells in the tissueappearance of the cells in the tissuesample reveals whether the lump issample reveals whether the lump isbenign, which is true of the vast majority,benign, which is true of the vast majority,or if it is cancerous.or if it is cancerous.
  6. 6. 6 JUN 10 FF6 JUN 10 FF 66 Type of Breast Cancer :Type of Breast Cancer : Ductal carcinoma in situ, is an early breast cancer in theDuctal carcinoma in situ, is an early breast cancer in themilk ducts. It can be detected by mammograms and ismilk ducts. It can be detected by mammograms and isnormally easy to cure.normally easy to cure. Lobular carcinoma in situ, this is not considered to beLobular carcinoma in situ, this is not considered to bebreast cancer but a pre-cancerous condition. They justbreast cancer but a pre-cancerous condition. They justhave an increasedhave an increased risk of breast cancerrisk of breast cancer, so they are, so they aregiven frequent checkups.given frequent checkups. Invasive lobular carcinoma, is a breast cancer that startsInvasive lobular carcinoma, is a breast cancer that startsin the lobules and has spread. Its may difficult toin the lobules and has spread. Its may difficult todiagnose because they do not always form a lump ordiagnose because they do not always form a lump orshow up on mammograms.show up on mammograms.
  7. 7. 6 JUN 10 FF6 JUN 10 FF 77 Types of Breast CancerTypes of Breast Cancer Ductal carcinomaDuctal carcinoma is the most common form of breast cancer.is the most common form of breast cancer.Tumors form in the cells of the milk ducts, which convey milk to theTumors form in the cells of the milk ducts, which convey milk to thenipples. Ductal carcinoma can either be invasive, with the potentialnipples. Ductal carcinoma can either be invasive, with the potentialto spread, or non-invasive.to spread, or non-invasive. Lobular carcinomaLobular carcinoma occurs in the lobules, which are the milk-occurs in the lobules, which are the milk-producing glands. Lobular carcinoma can be invasive, with aproducing glands. Lobular carcinoma can be invasive, with atendency to spread, or non-invasive.tendency to spread, or non-invasive. Inflammatory breast cancer (IBC)Inflammatory breast cancer (IBC) is a rare, aggressive form ofis a rare, aggressive form ofbreast cancer that affects the dermal lymphatic system. Rather thanbreast cancer that affects the dermal lymphatic system. Rather thanforming a lump, IBC tumors grow in flat sheets that cannot be felt informing a lump, IBC tumors grow in flat sheets that cannot be felt ina breast exam.a breast exam. Read more about IBCRead more about IBC Recurrent breast cancerRecurrent breast cancer means that the cancer has returnedmeans that the cancer has returnedafter being undetected for a time. Recurrent cancer can occur in theafter being undetected for a time. Recurrent cancer can occur in theremaining breast tissue, and also at other sites such as the lungs,remaining breast tissue, and also at other sites such as the lungs,liver, bones or brain. Even though these tumors are in a newliver, bones or brain. Even though these tumors are in a newlocation, they are still called breast cancer.location, they are still called breast cancer.
  8. 8. 6 JUN 10 FF6 JUN 10 FF 88 Symptoms include:Symptoms include: Lump or mass in your breastLump or mass in your breast Enlarged lymph nodes in the armpitEnlarged lymph nodes in the armpit Changes in breast size, shape, skin texture or colorChanges in breast size, shape, skin texture or color Skin rednessSkin redness Dimpling or puckeringDimpling or puckering Nipple changes or dischargeNipple changes or discharge ScalinessScaliness Nipple pulling to one side or a change in directionNipple pulling to one side or a change in direction Many breast changes – including lumps – are not cancer,Many breast changes – including lumps – are not cancer,but if you notice one or more of these symptoms forbut if you notice one or more of these symptoms formore than two weeks, see your doctor.more than two weeks, see your doctor.
  9. 9. 6 JUN 10 FF6 JUN 10 FF 99 Symptoms includeSymptoms include •• lump or mass in your breastlump or mass in your breast •• enlarged lymph nodes in the armpitenlarged lymph nodes in the armpit •• changes in breast size, shape, skinchanges in breast size, shape, skintexture or colortexture or color •• skin rednessskin redness •• dimpling or puckeringdimpling or puckering •• nipple changes or dischargenipple changes or discharge •• scalinessscaliness •• nipple pulling to one side or a change innipple pulling to one side or a change indirectiondirection
  10. 10. 6 JUN 10 FF 10• age Most cases occur in women 50 or older; it is less• common in women 35 or younger. Age is the most• influential risk factor.• • family history Your risk is higher with a family history• (especially mother, sister, daughter) of breast and/or• ovarian cancer.• • hormones / childbirth Your risk is higher if you had• your first period before age 12, began menopause after• age 55, never had children or had your first child after• age 30. Postmenopausal use of hormonal therapy• increases your risk of developing breast cancer.• • previous biopsy If you’ve had abnormal breast biopsy• results or benign breast diseases requiring biopsies, you• may be at increased risk. Other breast diseases such as• atypical hyperplasia, lobular or ductal carcinoma in situ• are risk factors, too.• • education / socioeconomic status Women with a• higher socioeconomic status and/or education tend to• have fewer children and start childbearing after age 30 –• both of which put them at higher risk.• • weight Obesity or weight gain after menopause are risk• factors.• • genetic alterations Inherited alterations in the genes,• called BRCA1 and BRCA2, account for about five to 10• percent of all breast cancer cases.• Other risk factors include:• • oral contraceptive use• • a diet high in saturated fats• • physical inactivity• • alcohol (more than one alcoholic drink a day)
  11. 11. 6 JUN 10 FF6 JUN 10 FF 1111 ScreeningScreening Cancer screening exams are medical tests that are performed whenCancer screening exams are medical tests that are performed whena person has no symptoms.a person has no symptoms. All women should be familiar with their breasts so that they willAll women should be familiar with their breasts so that they willnotice any changes and reportnotice any changes and report them to their doctor without delay. M. D. Anderson alsothem to their doctor without delay. M. D. Anderson alsorecommends the following:recommends the following: •• Clinical breast exams every one to three years beginning at ageClinical breast exams every one to three years beginning at age20.20. •• Yearly mammograms and clinical breast exams beginning at ageYearly mammograms and clinical breast exams beginning at age40 and continuing for40 and continuing for as long as a woman is in good health.as long as a woman is in good health. M. D. Anderson breast cancer experts recommend that all womenM. D. Anderson breast cancer experts recommend that all womenpractice “breast selfawareness”practice “breast selfawareness” (BSA) as part of the triad of breast cancer screening guidelines,(BSA) as part of the triad of breast cancer screening guidelines,which includeswhich includes breast exams by physicians (clinical breast exams) andbreast exams by physicians (clinical breast exams) andmammograms.mammograms. TipsTips ••
  12. 12. 6 JUN 10 FF6 JUN 10 FF 1212 TipsTips •• Schedule a clinical breast exam at the time of or just before yourSchedule a clinical breast exam at the time of or just before yourregularly scheduledregularly scheduled mammogram.mammogram. •• If you are age 35 or older, ask your doctor to calculate your breastIf you are age 35 or older, ask your doctor to calculate your breastcancer risk.cancer risk. •• Consider additional screening if you are at risk.Women atConsider additional screening if you are at risk.Women atincreased risk of breastincreased risk of breast cancer (e.g., family history, genetic predisposition, past breastcancer (e.g., family history, genetic predisposition, past breastcancer) should talk to theircancer) should talk to their doctor about the benefits and limitations of starting mammogramsdoctor about the benefits and limitations of starting mammogramsearlier, having additionalearlier, having additional test (e.g., breast ultrasound or MRI) or having more frequent exams.test (e.g., breast ultrasound or MRI) or having more frequent exams. These recommendations are provided as a guide. If exam resultsThese recommendations are provided as a guide. If exam resultssuggest cancer, more extensivesuggest cancer, more extensive diagnostic tests, such as an ultrasound or biopsy of the breastdiagnostic tests, such as an ultrasound or biopsy of the breasttissue, should be conductedtissue, should be conducted
  13. 13. 6 JUN 10 FF6 JUN 10 FF 1313 Reducing Your RiskReducing Your Risk You can take action to reduce your risk of developing breastYou can take action to reduce your risk of developing breast cancer. M. D. Anderson suggests:cancer. M. D. Anderson suggests: •• talking to your doctor about your use of oraltalking to your doctor about your use of oral contraceptives and hormonal therapycontraceptives and hormonal therapy •• maintaining your ideal weightmaintaining your ideal weight •• eating at least five servings of fruits and vegetableseating at least five servings of fruits and vegetables per dayper day •• following recommended screening guidelinesfollowing recommended screening guidelines •• exercising regularlyexercising regularly •• eliminating tobacco use and using alcohol in moderationeliminating tobacco use and using alcohol in moderation •• getting your breast cancer risk assessedgetting your breast cancer risk assessed •• if you’re at increased risk, talk to your doctor aboutif you’re at increased risk, talk to your doctor about medications that can reduce your risk of developingmedications that can reduce your risk of developing breast cancer.breast cancer. Take time to discuss your own risks with your health careTake time to discuss your own risks with your health care
  14. 14. 6 JUN 10 FF6 JUN 10 FF 1414 Biopsy:Biopsy: a small sample of the suspicious area of thea small sample of the suspicious area of thebreast is removed for examination under a microscope.breast is removed for examination under a microscope.Biopsies can be done in the following ways:Biopsies can be done in the following ways: Surgical biopsy:Surgical biopsy: an incision is made in the breast.an incision is made in the breast.Surgeons locate the tumor by palpation or with the aid ofSurgeons locate the tumor by palpation or with the aid ofimages from a CT scan, ultrasound or mammogram. Inimages from a CT scan, ultrasound or mammogram. Inanan excisional biopsyexcisional biopsy , the entire mass is removed. In, the entire mass is removed. Inanan incisional biopsyincisional biopsy , only a portion of the tumor is, only a portion of the tumor isremoved.removed. Fine Needle Aspiration (FNA):Fine Needle Aspiration (FNA): a thin, hollow needlea thin, hollow needleis inserted into the breast to the tumor, and fluid andis inserted into the breast to the tumor, and fluid andcells are removed from the tumor. While this test cancells are removed from the tumor. While this test canhelp to determine if there is cancer present, it cannothelp to determine if there is cancer present, it cannotdetermine if the cancer is invasive and additionaldetermine if the cancer is invasive and additionalbiopsies may be needed if cancer is actually present.biopsies may be needed if cancer is actually present. Core biopsy:Core biopsy: a thicker needle is used to remove one ora thicker needle is used to remove one ormore small cylinder-shaped tissue samples from themore small cylinder-shaped tissue samples from thetumor.tumor.
  15. 15. 6 JUN 10 FF6 JUN 10 FF 1515 shaped tissue samples from the tumor.shaped tissue samples from the tumor. Diagnostic mammogram:Diagnostic mammogram: this procedure is similar tothis procedure is similar tothe mammogram used for screening, but provides morethe mammogram used for screening, but provides moredetailed images of the breast tissue.  detailed images of the breast tissue.   Magnetic Resonance Imaging (MRI):Magnetic Resonance Imaging (MRI): images ofimages ofthe breast are created with powerful magnets thatthe breast are created with powerful magnets thatinteract with a computer.interact with a computer. Ultrasound:Ultrasound: a special wand placed against the skina special wand placed against the skintransmits sound waves, which bounce off breast tissuetransmits sound waves, which bounce off breast tissueand are used create an image on a monitor. and are used create an image on a monitor.  Sentinel lymph node biopsy:Sentinel lymph node biopsy: lymph nodes are olive-lymph nodes are olive-sized glands which are part of a system that circulatessized glands which are part of a system that circulateslymph fluid throughout the body. The lymphatic systemlymph fluid throughout the body. The lymphatic systemcan also carry cancer cells from the tumor site to othercan also carry cancer cells from the tumor site to otherareas of the body. In breast cancer patients, the firstareas of the body. In breast cancer patients, the firstnodes to be affected are under the armnodes to be affected are under the arm
  16. 16. 6 JUN 10 FF 16Staging TNM SYSTEM• Primary tumor (T)• Tx: Primary tumor cannot be assessed• T0: No evidence of primary tumor• Tis: (DCIS) Carcinoma in situ• Tis: (LCIS) Carcinoma in situ• Tis: Paget disease of the nipple with no tumor (Paget diseaseassociated with a tumor is classified according to the size of thetumor.)• T1: Tumor 2 cm or smaller in greatest diameter– T1mic: Microinvasion 0.1 cm or less in greatest dimension– T1a: Tumor >0.1 but not >0.5 cm in greatest diameter– T1b: Tumor >0.5 but not >1 cm in greatest diameter– T1c: Tumor >1 cm but not >2 cm in greatest diameter• T2: Tumor >2 cm but not >5 cm in greatest diameter• T3: Tumor >5 cm in greatest diameter• T4: Tumor of any size, with direct extension to (a) the chest wall or (b)skin only, as described below– T4a: Extension to the chest wall, not including the pectoralis muscle– T4b: Edema (including peau d’orange) or ulceration of the skin of the breastor satellite skin nodules confined to the same breast– T4c: Both T4a and T4b– T4d: Inflammatory disease
  17. 17. 6 JUN 10 FF 17• Regional lymph nodes (N)• Nx: Regional lymph nodes cannot be assessed (eg, previouslyremoved)• N0: No regional lymph node metastasis• N1: Metastasis in movable ipsilateral axillary lymph node(s)• N2: Metastasis in ipsilateral axillary lymph node(s) fixed or matted,or in clinically apparent ipsilateral internal mammary nodes in theabsence of clinically evident axillary lymph node metastasis– N2a: Metastasis in ipsilateral axillary lymph nodes fixed to one anotheror to other structures– N2b: Metastasis only in clinically apparent ipsilateral internal mammarynodes and in the absence of clinically evident axillary lymph nodes• N3: Metastasis in ipsilateral infraclavicular or supraclavicular lymphnode(s) with or without axillary lymph node involvement, orclinically apparent ipsilateral internal mammary lymph node(s) andin the presence of axillary lymph node– N3a: Metastasis in ipsilateral infraclavicular lymph node(s)– N3b: Metastasis in ipsilateral internal mammary lymph node(s) andaxillary lymph node(s)– N3c: Metastasis in ipsilateral supraclavicular lymph node(s)
  18. 18. 6 JUN 10 FF 18• Distant metastasis• Mx: Distant metastasis cannot beassessed• M0: No distant metastasis• M1: Distant metastasis
  19. 19. 6 JUN 10 FF6 JUN 10 FF 1919 Table 2. TNM Staging System for Breast CancerTable 2. TNM Staging System for Breast CancerOpen table in new windowOpen table in new window [ CLOSE WINDOW ][ CLOSE WINDOW ] TableTable StageTumorNodeMetastasesStageTumorNodeMetastases Stage 0TisN0M0Stage IT1N0M0Stage IIAT0Stage 0TisN0M0Stage IT1N0M0Stage IIAT0T1T1T2N1T2N1N1N1N0M0N0M0M0M0M0Stage IIBT2M0Stage IIBT2T3N1T3N1N0M0N0M0M0Stage IIIAT0M0Stage IIIAT0T1T1T2T2T3N2T3N2N2N2N2N2N1-2M0N1-2M0M0M0M0M0M0Stage IIIBT4M0Stage IIIBT4T4T4T4N0T4N0N1N1N2M0N2M0M0M0M0Stage IIICAny TN3M0Stage IVAny TAny NM1M0Stage IIICAny TN3M0Stage IVAny TAny NM1StageTumorNodeMetastasesStageTumorNodeMetastases Stage 0TisN0M0Stage IT1N0M0Stage IIAT0Stage 0TisN0M0Stage IT1N0M0Stage IIAT0T1T1T2N1T2N1N1N1N0M0N0M0M0M0M0Stage IIBT2M0Stage IIBT2T3N1T3N1N0M0N0M0M0Stage IIIAT0M0Stage IIIAT0T1T1T2T2T3N2T3N2N2N2N2N2N1-2M0N1-2M0M0M0M0M0M0Stage IIIBT4M0Stage IIIBT4T4T4T4N0T4N0N1N1N2M0N2M0M0M0M0Stage IIICAny TN3M0Stage IVAny TAny NM1M0Stage IIICAny TN3M0Stage IVAny TAny NM1
  20. 20. 6 JUN 10 FF6 JUN 10 FF 2020THERAPIE :THERAPIE :1.OPERASI.1.OPERASI.2.CHEMOTHERAPIE.2.CHEMOTHERAPIE.3.RADIASI.3.RADIASI.4.HORMONAL.4.HORMONAL.
  21. 21. 6 JUN 10 FF6 JUN 10 FF 2121PROGNOSA :PROGNOSA :TERGANTUNG STADIUM.TERGANTUNG STADIUM.
  22. 22. 6 JUN 10 FF6 JUN 10 FF 2222
  23. 23. 6 JUN 10 FF6 JUN 10 FF 2323
  24. 24. 6 JUN 10 FF6 JUN 10 FF 2424
  25. 25. 6 JUN 10 FF6 JUN 10 FF 2525
  26. 26. 6 JUN 10 FF6 JUN 10 FF 2626 Facing a mirrorFacing a mirror Stand before a mirror and compare both breasts for differencesStand before a mirror and compare both breasts for differencesin size, nipple inversion (turning in), bulging, or dimpling. Note anyin size, nipple inversion (turning in), bulging, or dimpling. Note anyskin or nipple changes, such as a hard knot orskin or nipple changes, such as a hard knot or nipple dischargenipple discharge.. Inspect your breasts in the following 4 steps:Inspect your breasts in the following 4 steps:– With yourWith your armsarms at your sidesat your sides– With your arms overheadWith your arms overhead– With your hands on hips - Press firmly to flex yourWith your hands on hips - Press firmly to flex your chestchest muscles.muscles.– Bent forward - Inspect your breasts.Bent forward - Inspect your breasts. In these positions, your pectoral muscles are contracted, and aIn these positions, your pectoral muscles are contracted, and asubtle dimpling of the skin may appear if a growing tumor hassubtle dimpling of the skin may appear if a growing tumor hasaffected a ligamentaffected a ligament
  27. 27. 6 JUN 10 FF6 JUN 10 FF 2727 Lying downLying down Right breastRight breastand Left breastand Left breast– Place a pillow under your right shoulder.Place a pillow under your right shoulder.– Put your right hand under your head.Put your right hand under your head.– Check the entire breast area with the finger pads of your left hand.Check the entire breast area with the finger pads of your left hand.– Use small circles and follow an up-and-down pattern.Use small circles and follow an up-and-down pattern.– Use light, medium, and firm pressure over each area of the breast.Use light, medium, and firm pressure over each area of the breast.– Feel the breast with the surfaces of the second, third, and fourth fingers, movingFeel the breast with the surfaces of the second, third, and fourth fingers, movingsystematically and using small, circular motions from the nipple to the outersystematically and using small, circular motions from the nipple to the outermargins.margins.– Gently squeeze the nipple for any discharge.Gently squeeze the nipple for any discharge.
  28. 28. 6 JUN 10 FF6 JUN 10 FF 2828 In the showerIn the shower A BSE can easily be performed while youre in the bathA BSE can easily be performed while youre in the bathor shower. Some women discover breast masses whenor shower. Some women discover breast masses whentheir skin is moist.their skin is moist.– Raise your right arm.Raise your right arm.– With soapy hands and fingers flat, check your right breast.With soapy hands and fingers flat, check your right breast.– Use the same small circles and up-and-down pattern describedUse the same small circles and up-and-down pattern describedearlier.earlier.– Repeat on the left breast.Repeat on the left breast.
  29. 29. 6 JUN 10 FF6 JUN 10 FF 2929
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  31. 31. 6 JUN 10 FF6 JUN 10 FF 3131
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