In short about breast cancer & its management

1. Presented by:
Dr. Md.Shahadad Hossain
Department of Surgery

2. Introduction:
Breast cancer is the most common
Cause of death in middle aged
family in western countries. In
2010 approximately one & three
quarter million new cases were
diagnosed worldwide. Worldwide
1 in 8 woman will develop the
disease during there life time.

4. Aeitiology/Risk factors of Ca-brep-[breast:
Exact cause in unknown but predisposing factors
are-
• Geographical: Commonly occurs in western
world (rare in Japan). Accounting for 3-5
percent of all deaths in the developed countries
it accounts are 1-3 percent of death.
• Age: Extremely rare in less than 20 years, risk
rises with age.
• Race: It is common white > Black
• Gender: Less than 5% occurs in male
• Genetic: Common in female with positive family
history
• Diet: Low in phytoestrogen excessive alcohol.

5. • Endocrine: Common in multiparous.
• Personal history of breast cancer: A Women
who had breast cancer in one breast has
an increased risk of getting cancer in her
other breast.
• Previous radiation
• Post-menopausal women who take
hormone therapy.
• Obesity
• Early menarche & late menopases
• Some genetic pre disposing factors BRCA-1,
BRCA-2

6. Types of breast Cancer
1. Ductal Carcinoma:
- Ductal Carcinoma in situ not crossed
basement membrane
- Invasive ductal carcinoma crossed the
basement membrane
2. Lobular carcinoma:-
- Lobular carcinoma in situ
- Invasive Lobular carcinoma

7. Clinical Classification:
1. Scirrhous (Commonest)
2. Atrophic scirrhous carcinoma
3. Inflammatory carcinoma
4. Paget’s disease of the nipple
5. Lipomators carcinoma.

8. Typical presentation: -
1. breast lump:- Recently noticed hard
painless breast lump in perimanopausal
woman
•Hard
•None-tender
•Rapidly increasing in size
•Sur face irregular
•Fixed with overlying & underlying
structures.
2. Nipple change: -
•Retraction
•Deviation
•Ulceration
•Bloody discharge.

9. 3. Skin Change: -
•Dimpling
•Puckering
•Paud-orange
4. Axillary Lymph adenopathy
5. Distal metastasis
•Lung
•Liner
•Bone
•Adrenal gland

10. Early warning signs are:
•Visible lump
•Nipple Chang – Ex-inversion
•Colour or texture change
•Dimpled or depressed skin
•Bloody discharge

11. Route of spread of CA-breast:
1. Local Spread;
• Pectoral muscle
• Chest wall
• Skin
2. Lymphatic metastasis:
• Axillary lymph nodes
• Internal mammary chain of lymph nodes
• Supra Clavicular
• Contralateral lymph nodes
3. Spread by the blood stream:
• Liver
• Lungs
• Brain
• Adermal glands
• Ovaries.

12. Diagnosis:
by triple assessment
Clinical Examination - In 3 Position
1. Sitting
2. Recumbant
3. Lying
Procedure
•1st – Opposite breast and axilla.
•2nd- Affected breast and axilla
•3rd - Site of metastasis

14. How to Examine : -
1. consent
2. Female attendant if not present only
husband can be allowed.
3. Privacy
4. Adequate to exposure up to the wist
5. Position
•Sitting upright to see breast change & axilla.
•Linning forward
•lying position
oinspection
oPalpation according to quardants
Upper & inner 12%
Upper & outer 60%
Lower & inner 6%
Lower & outer 10%
Central 12%

15. If any lump found then examination of the lump
•Size
•Shape
•Consistency
•Fixety
6. Lymph node examination:
•Anterior
•Posterior
•Lateral
•Cental
•Apical
Also involve internal mammary Lymph node which
we can four by CT- scan of chest.

16. 7. Chest Examination: -
•Inspection
•Palpation
•Percussion
•Auscultation
8. Abdomen:-
•Liver
•Ascites for ovarian metastesis
9. Bone: Spine examination

18. Investigation:
•< 35 Years –USG
•>35 Years – Mammography
•Any age if huge lump-FNAC
•Chest X-ray
•USG of W/A
•Bone scan Isotope bene scan
•CT- scan of Brain

19. Specific Investigation
Mammography:
Findings:
Hard dense area.
Irregular
Micro calcification
Distortion of subcutaneous fat
FNAC: FNA of breast lump/ axillary lymph
node 95 percent accuracy only 5% case
histopathology is required for confirmation
Core biopsy/trucut bipoy
Cytology of nipple discharge (if any)

20. Staging:
TNM staging
Machester Staging
TNM
T-Tumour
T1- 1-2 cm
T2- 2-5 cm
T3- 5-10 cm
T4- more than 410 cm
If skin involved it is always T4.

21. N- Nodal involvements
N0- No Nodal involvement
N1- Nodal Involvement but
mobile
N2- Nodal Involvement & Fixed .
M- Metastasis
M0- No distal Metastasis
M1- Distal Metastases

23. Treatment Options:-
•Surgery
•Radiotherapy
•Chemotherapy
•Hormontharapy
•Immunotherapy

24. Surgery

25. Surgery
Types:
1. Breast consuving surgery
2. Radical surgery
3. Breast reconstruction

26. 1. Breast consuving surgery :
Wide local excision
Quadrandectomy
Followed by radiotherapy in residual breast
2. Redical Surgery
Simple Mastectomy
Modified redical mastectomy
Redical Mastectomy
Toilet Mastectomy
3. Breast Reconstruction:
Myocutaneous flap:
TRAM- Transverse reetus abdominis muscle flap
Lattisimus dorsi muscle flap
Breast Prosthesis
External
Internal silicon implant subcutaneously

27. Axillary Surgery:
1. Centinal node biopsy
2. Axillary sampling- only nodes
3. Axillary clearance
• lymph node, fascia, muscle, fat

28. Preventive factors:
1. Regular exercise
2. Healthy food habits. antioxidant containing food
3. Avoid high calori food
4. Breast feeding

30. Prognosis:
The best indicators of likely
prognosis in breast cancer
remain tumor size, grade and
lymph node status, however it
is realized that some large
tumours will remain confined
to the breast.

31. Thank You